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Temporal Relations Among Changes in Activation, Avoidance, and Anxiety in the Unified Protocol

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Abstract

Behavioral activation and experiential avoidance are considered closely related transdiagnostic constructs. Decreases in behavioral activation and increases in avoidance are both thought to play a role in the maintenance of emotional disorder symptoms. Using a series of random intercept cross-lagged panel models, this study examined the temporal relations between change in behavioral activation, experiential avoidance, and anxiety symptoms during outpatient administration of the Unified Protocol. Between-person results demonstrated that greater avoidance was associated with lower activation, and more severe anxiety symptoms were associated with both greater avoidance and lower activation. Within-person results suggested that improvements in avoidance tended to predict increased activation and decreased anxiety symptoms. Changes in activation did not substantially predict changes in avoidance or anxiety. Overall, these results provide preliminary information on the timing of important therapeutic processes and may shed light on how clinicians should prioritize targets.

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  1. Similarly, across all 12 weeks, participants reported large, significant reductions in behavioral avoidance, B = -.71, SE = .12, p < .01, 95% CI [-.96, -.47], d = .79; medium-sized, significant reductions in anxiety, B = -.16, SE = .04, p < .01, 95% CI [-.24, -.08], d = .54; and small-sized, significant increases in behavioral activation, B = .09, SE = .05, p = .03, 95% CI [.01, .19], d = .26. These 12-week changes in behavioral avoidance, B = .32, SE = .30, p = .29, 95% CI [-.29, .93]; anxiety, B = .08, SE = .08, p = .37, 95% CI [-.08, .24]; and behavioral activation, B = -.20, SE = .12, p = .11, 95% CI [-.44, .04], did not significantly differ by duration condition.

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M.W.S.’s effort on this project was partially supported by the National Institute of Mental Health under award number K23MH126211. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institute of Health.

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  1. Department of Psychology, University of Kentucky, Kastle Hall 111D, Lexington, KY, 40508, USA

    Doug R. Terrill, Matthew W. Southward, Lindsey Crowley, Riley Feddock, Madeline L. Kushner & Shannon Sauer-Zavala

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Terrill, D.R., Southward, M.W., Crowley, L. et al. Temporal Relations Among Changes in Activation, Avoidance, and Anxiety in the Unified Protocol. J Psychopathol Behav Assess 46, 147–157 (2024). https://doi.org/10.1007/s10862-023-10099-9

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